3038 — Older Veterans Treated and Released from VAMC Emergency Departments
Hastings SN (Durham COE & GRECC), Smith VA
(Durham COE), Weinberger M
(Durham COE), Schmader KE
(Durham GRECC), Olsen MK
(Durham COE), Oddone EZ
To describe older veterans who were treated and released from VAMC emergency departments (EDs) and to identify the frequency of, and risk factors for, repeat ED visits and hospitalizations.
We assembled a nationally representative sample of veterans aged > = 65 years who visited one of 102 VAMC EDs between 10/1/07 and 6/30/08 (n = 42,808). Primary outcomes were ED visits and hospital admissions within 30 days after the index ED visit. Logistic regression models, adjusted for clustering of patients within facilities, were used to examine the association between independent variables and outcomes. We report odds ratios (OR) and 95% confidence intervals (CI).
At their index ED visit, 73.4% of older veterans (mean age 75.6 years) were treated and released (n = 31,442). ED diagnoses at the index visit were commonly related to chronic conditions (22.5%), injuries/ acute musculoskeletal conditions (19%), and infections (13.4%). Within 30 days, 21% of older veterans had returned to the ED (n = 4,809) or been hospitalized (n = 2,101). In adjusted models, factors associated with increased odds of repeat ED visits included homelessness (OR 1.7, 95% CI 1.3, 2.1), previous ED visits (OR 1.7, 95% CI 1.6, 1.8) , previous hospitalization (OR 1.3, 95% CI 1.2, 1.4) and an index ED visit related to infection (1.2, 95% CI 1.1, 1.3). Odds of subsequent hospital admission were higher among veterans with previous hospitalization (OR 2.3, 95% CI 2, 2.6), homelessness (OR 1.6, 95% CI 1.2, 2.2), Aid and Attendance benefits (OR 1.5, 95% CI 1.2, 1.8), higher co-morbidity scores (OR 1.3, 95% CI 1.2, 1.3), unmarried (OR 1.2, 95% CI 1.1, 1.4) and an index ED visit related to a chronic condition (OR 1.2, 95% CI 1.1, 1.4).
A substantial proportion of older veterans treated and released from the ED returned to the ED or were hospitalized within 30 days. Previous hospital or ED use are key predictors of subsequent utilization, but other indicators of medical need and inadequate social support also identify veterans at risk.
Treat and release ED visits may be important intervention points for reducing unscheduled health care use among high risk older veterans.